Novel short-term hypothermic oxygenated perfusion (HOPE) system prevents injury in rat liver graft from non-heart beating donor

P Dutkowski, K Furrer, Y Tian, R Graf… - Annals of surgery, 2006 - journals.lww.com
P Dutkowski, K Furrer, Y Tian, R Graf, PA Clavien
Annals of surgery, 2006journals.lww.com
Objective: To assess a machine perfusion system in rescuing liver grafts from non-heart-
beating donors (NHBD). Summary Background Data: The introduction of extracorporeal liver
perfusion systems in the clinical routine depends on feasibility. Conceivably, perfusion could
be performed during recipient preparation. We investigated whether a novel rat liver
machine perfusion applied after in situ ischemia and cold storage can rescue NHBD liver
grafts. Methods: We induced cardiac arrest in male Brown Norway rats by phrenotomy and …
Objective:
To assess a machine perfusion system in rescuing liver grafts from non-heart-beating donors (NHBD).
Summary Background Data:
The introduction of extracorporeal liver perfusion systems in the clinical routine depends on feasibility. Conceivably, perfusion could be performed during recipient preparation. We investigated whether a novel rat liver machine perfusion applied after in situ ischemia and cold storage can rescue NHBD liver grafts.
Methods:
We induced cardiac arrest in male Brown Norway rats by phrenotomy and ligation of the subcardial aorta. We studied 2 experimental groups: 45 minutes of warm in situ ischemia+ 5 hours cold storage versus 45 minutes of warm in situ ischemia+ 5 hours cold storage followed by 1 hour hypothermic oxygenated extracorporeal perfusion (HOPE). In both groups, livers were reperfused in a closed sanguineous isolated liver perfusion device for 3 hours at 37 C. To test the benefit of HOPE on survival, we performed orthotopic liver transplantation in both experimental groups.
Results:
After cold storage and reperfusion, NHBD livers showed necrosis of hepatocytes, increased release of AST, and decreased bile flow. HOPE improved NHBD livers significantly with a reduction of necrosis, less AST release, and increased bile flow. ATP was severely depleted in cold-stored NHBD livers but restored in livers treated by HOPE. After orthotopic liver transplantation, grafts treated by HOPE demonstrated a significant extension on animal survival.
Conclusions:
We demonstrate a beneficial effect of HOPE by preventing reperfusion injury in a clinically relevant NHBD model.
Lippincott Williams & Wilkins